Kimberly Kristi Smith, APRN-NP
Individual provider Active NPI Family Nurse Practitioner · Grants Pass, OR
NPI 1316628860 · NPPES record last updated Jul 27, 2023
Key facts
- NPI
- 1316628860
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 10012858 (OR)
- Practice address
- 1701 NW Hawthorne Ave
Grants Pass, OR 97526-1051 - Phone
- (541) 471-3455
- NPI assigned
- Jul 27, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Siskiyou Community Health Center Inc
Practice addresses (Care Compare)
1701 NW Hawthorne Ave
Grants Pass, OR 97526-1051
Phone (541) 472-4777
Hospital & facility affiliations
- Asante Three Rivers Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231107001929 | OR | Practitioner - Nurse Practitioner | 4183071509 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Siskiyou Community Health Center, Inc | Current | Accepting new patients | |
| Siskiyou Community Health Center, Inc. | Current |
Accepting new patients |
Locations
1701 NW Hawthorne Ave
#201
Grants Pass, OR 97526
1701 NW Hawthorne Ave
Grants Pass, OR 97526
Phone (541) 471-3455
Interoperability endpoints
- kim.smith.p1@direct.siskiyou.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 10012858 | OR | Yes |
Addresses
Primary practice location
1701 NW Hawthorne Ave
Grants Pass, OR 97526-1051
Mailing address
1701 NW Hawthorne Ave
Grants Pass, OR 97526-1051
Phone (541) 471-3455
Other providers in Grants Pass, OR
- Jo Anne Marie Smith
- John H Smith
- Kaylie Michelle Smith
- Kenneth David Smith
- Kianne Rachelle Smith
- Letty Smith
- Lori Elizabeth Smith
- Lori Lynn Smith
- McKenzie Smith
- Phyllis Biergie Smith
All providers in Grants Pass, OR · Family Nurse Practitioner in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 27, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.